FREE Sports Physicals

Posted on February 17, 2015.

The Safe Sports Network free sports physical clinic will once again be heldĀ at our Bedford ... Read More

Tuesday, January 27th

Posted on January 26, 2015.

PLEASE BE ADVISED: Our offices will not be seeing patients tomorrow January 27th. We will ... Read More

2015 Safe Sports Social Announced

Posted on January 21, 2015.

Nowadays most high school teams have on site athletic trainers to assist in treating injuries ... Read More

New Hampshire Orthopaedic Center


Posted on February 23, 2015.

By: Kathleen A. Hogan, MD

With the arrival of cold and snow, many people head south for warmer weather. One of the many reasons older people leave New Hampshire during the winter months is that their arthritic joints feel better in a warmer climate. Certainly, avoiding snow and ice can minimize your chance of falling and breaking bones. But does warmer weather really influence the pain from arthritic joints?

First, it is important to understand how arthritis causes pain. Arthritis refers to the loss of the normal cartilage that covers the ends of the bones. Instead of two smooth surfaces gliding past each other, they are now rough. Joint fluid coats the surfaces, providing lubrication. Arthritis causes pain because of the resulting inflammation, swelling, and loss of motion. So how does changes in climate affect these sources of pain?

Ice has been shown to decrease inflammation in joints, which is why icing is a commonly recommended treatment for arthritic joints. But, even when the air temperature is cold, your body acts to keep its internal temperatures relatively constant. Joints further away from the heart (fingers/toes) may become cold, but the body temperature at the knees and hip are relatively constant despite the cold air. Warmer climates do not necessarily decrease inflammation or swelling in your joints. The few studies that have been done on this topic have not found clear correlation between musculoskeletal pain and temperature.

However, cold air temperatures can make joints and muscles feel stiff and less limber. When the weather is unpleasant, people are naturally less likely to go outside and exercise. Joints that do not move become stiffer. Stiffness causes pain. This is probably the main reason arthritis pain feels better in transitioning to a warmer climate in the middle of winter.

If you are staying in New Hampshire this winter, you can mimic some of these effects seen in the warmer climates. Wear warm, compressive clothing around your painful joints to keep them from feeling stiff. Consider using a heating pad on sore joints to help warm them up prior to activities. Do not let the cold weather keep you from being active. Activity is beneficial to arthritic joints!

When you are outdoors this winter, make sure to be wary of ice. Falls are a frequent occurrence in the winter and if your bones are osteoporotic, even a small slip can result in a broken wrist or hip. Wear sensible shoes, pay attention to where you are walking, make sure you de-ice walkways and stairs outside your home. Canes can slip on the ice and water as well. Four prong canes and walkers are slightly more steady. Be particularly careful if you have broken a bone before; prior fractures are often a sign that your bones are fragile and prone to breaking.

Outpatient Joint Replacement?

Posted on January 3, 2015.

By: Kathleen A. Hogan, MD

When knee and hip replacements were first developed, most patients would stay in the hospital for a minimum of a week, sometimes longer. This lengthy hospital stay was felt to be necessary for patients to get the physical therapy and care they required for full recovery. Today, many patients remain in the hospital for two or three nights after joint replacement. But why? Certainly if a patient has diabetes, cardiac disease, kidney problems, sleep apnea or COPD it is important to be monitored closely for the first few days after surgery to ensure that there are no medical complications following surgery. But what about someone without any of these medical problems? Do they need to stay in the hospital just for physical therapy? In the hospital, physical therapists work with joint replacement patients only once or twice a day. This could certainly be done at home.

But what’s wrong with staying at the hospital for a few days? Many people prefer the comforts of home to the sterile conditions of a hospital. While at the hospital, you may be exposed to patients who are sick with the flu or other illnesses. Bacteria found in hospitals is often resistant to many antibiotics. Nurses wake you up to check on you at night and control when you receive medication. Nurses will take care of several patients and may not be available immediately. Most common post-operative problems such as swelling, wound drainage, and blood clots can be managed by your surgeon in the office if they occur. Hospital care is also very expensive; hospital and implant costs make up the majority of your bill.

Hip and knee replacements can be painful. Improved pain control with the use of long lasting nerve blocks, multimodal pain management, and intra-articular injections can reduce that pain to a manageable level with oral narcotics. Rotator cuff repair and ACL reconstruction are also painful procedures that used to require a short stay in the hospital but are now outpatient surgeries.

Outpatient hip and knee surgeries are performed at a surgical center, not at the hospital. Patients stay overnight for observation and go home the next morning. Nurses teach patients how to use crutches or a walker. One nurse is assigned to a maximum of two patients. Physical therapists visit patients at home until they can travel to a therapy office. The surgeon is available for the patient to call if there are any questions or problems at home.

Not every patient is a candidate for an outpatient hip or knee replacement. However there is no need for lengthy hospital stays for healthy patients after joint replacement. For carefully selected patients, home can be a safer and more comfortable place to recover after surgery than the hospital.

Tai Chi & Balance

Posted on December 29, 2014.

By: Lindsay Fortin, MPT

Falls due to a loss of balance are the leading cause of injury in adults over 65. In fact, one in three older adults will experience a fall each year resulting in injuries ranging from minor bruising to more serious injuries like dislocations, fractures or even head injuries. These injuries can require emergency room visits, hospital stays, surgery, and the person’s loss of function and independence. Unfortunately, many people see balance issues and falls as an unavoidable, untreatable side effect of aging, but loss of balance can be due to many causes. These can include, but are not limited to: vision or hearing deficits, dizziness secondary to blood pressure issues or medications, inner ear problems, neuropathy, impaired proprioception due to injury, or weaknesses.

Simple modifications to medications, eye glass prescriptions, and use of proper footwear can address some of these causes. Adequate lighting and picking up any hazardous items around the house, like scatter rugs, dog toys, or electric cords, can also help. A physical therapist can determine if a person is appropriate for a program to address an injury or weakness that may be contributing to balance deficits and discuss if the use of an assistive device may help prevent future falls. Regular exercise can help with circulation, mobility, and strength.

Tai chi has shown to be an especially effective form of exercise for the older population with a high fall risk. Tai chi is an ancient Chinese martial art that involves a series of slow, rhythmic movements to increase focus and relaxation. These movements require weight shifting, double and single leg stances, and are combined with head, trunk, and upper extremity motions. Tai chi is used in China for self-defense and meditation, but recent research has also shown tai chi to help improve balance, decrease fear of falls, increase strength, aerobic capacity, and endurance in adults over 65.

Tai chi can be performed by nearly anyone because it can be done standing, but also seated. It is low impact and very gentle on muscles and joints. It can be done in very little space with no equipment and at your own pace, which makes it a good option for those with a history of orthopedic injuries or surgeries, living in a small apartment or mobile home, on fixed incomes that are unable to buy gym memberships or exercise equipment, or with no previous exercise experience.

Falls are not an inevitable part of aging. There are many options to prevent falls and also to improve strength and balance once falls have already occurred. It is important to make sure we educate our patients about these options to help them stay safe and injury-free.

Seasonal Tips for Autumn

Posted on November 3, 2014.

By: Kathleen A. Hogan, MD

The hot days of summer are drawing to a close, replaced by cool, crisp fall evenings. As leaves change color, and kids go back to school, our focus shifts from fun times on the beach to preparing your home and yard for the winter season ahead.

Autumn is also a good time to take care of yourself. As you winterize your house, think about preparing yourself for winter as well. Have you had a check up this year with your primary care physician? Have you put off dealing with that nagging knee injury that hampered your golf game all summer? Do your hips and knees ache with the mere thought of the cold and damp days ahead? Or have you been putting off going to physical therapy or even having surgery, not wanting to take the time during the summer to get these things done? Autumn is a great time to re-assess your health and to stop procrastinating.

If you need a hip or knee replacement, autumn can be an excellent time to go ahead with surgery. Recovery after hip or knee replacement averages 6-12 weeks. For the first month and a half, patients are usually using a walker, crutches, or cane. Crutches are no fun in the snow! You should be well on your way to recovery before the busy holiday season. Also, if you have a high-deductible health insurance plan and have already met your deductible, it can make financial sense to go forward with higher cost procedures before that deductible is reset in January.

Take the time to make your health a priority this autumn. If you have problems with your knees or hips or other joints that you have been ignoring all summer long, make an appointment with an orthopaedic surgeon to find out what is wrong. Sometimes surgery is needed, but often medications, injections, or physical therapy can improve your symptoms and your quality of life.

Hike Your Way to Health – By: William P. Rix, MD

Posted on October 14, 2014.

Orthopaedic surgeons strongly recommend a regular exercise program to promote musculoskeletal health. An ideal exercise is one that is aerobic, strengthens the core as well as all four extremities, improves balance, is low impact, reasonably safe, and is able to be performed throughout life.

The sport of hiking fulfills all the above criteria. It is a “controlled” sport where the chance of injury is low. Hiking is classified as a “moderate dynamic loading” activity. This is in contrast to the high impact, high intensity sports such as hockey, football and basketball. There is now scientific evidence that moderate loading sports are beneficial and protective to the articular cartilage that lines all our joints. This is important because arthritis is a degenerative disease of articular cartilage. Moderate loading sports such as hiking can potentially protect joints against arthritis.

The startup costs of hiking are modest, and it can be a social (group hiking) or solitary activity. In New Hampshire we are blessed with endless hiking trails on mountains from 2000 to 6000 feet. The introductory hiker should start small and increase the intensity and duration of the hikes as he or she becomes more fit. I strongly recommend hiking with two walking poles as it broadens one’s base of support, and exercises all four extremities. The basic equipment includes sturdy boots, a comfortable daypack, inclement weather clothing, a map, compass, food and water. For a complete list of items recommended for a day hike, one should consult hiking websites such as The Appalachian Mountain Club.

The attractiveness of hiking is in its variability. By varying the length (miles), difficulty (roughness of the terrain) and steepness (elevation gain/distance) on successive outings, one can hike to get in shape, rehabilitate from an injury or maintain a desired level of fitness. As a bonus, the endpoint of a day’s outing is often a breathtaking view, a waterfall, or a mountain lake. I would recommend keeping a log of your successive hikes as you monitor your improved fitness or rehabilitation.

The following is a small sampling of progressively more demanding day hikes (Introductory 1 through 4; Moderate 5 through 8; Challenging 9 through 12):

Trail Mountain Round Trip



Gain (ft)

1. Mount Pemigewasset Trail Mount Pemigewasset 3 miles 1100
2. Barlow Trail Mount Kearsarge(South) 3.6 miles 1100
3. Andrew Brook Trail Mount Sunapee(L.Solitude) 4 miles 1100
4. Willard Trail Mount Willard 3.5 miles 1000
5. Morgan and Percival Trail Mount Morgan and Percival 5 miles 1500
6. Tecumseh Trail Tecumseh Trail 5 miles 2200
7. Welch-Dickey Trail Welch and Dickey 5 miles 1800
8. Sandwich Mountain Trail Jennings Peak 6 miles 1900
9. Airline Trail Mount Adams 9 miles 4500
10. Franconia Ridge Trail Loop Mount Lafayette, Lincoln & Haystack 8 miles 3500
11. Beaver Brook Trail Mount Moosilauke 8 miles 3100
12. Tuckerman Ravine Trail Mount Washington 8.5 miles 4250















For more trail recommendations, consult manuals like the AMC White Mountain Guide, the Falcon Series on Hiking NH, or 50 Hikes in New Hampshire by Daniel Doan.

And the next time someone snaps “Hey, why don’t you take a hike?”, say “Thanks for the good advice, I’ll do it”.